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<p>A problem with medical care economics is that the lower cost stuff that is more easily subject to free markets influences individually predictable likelihoods of certain catastrophic costs, which causes a free market for insurance for catastrophic costs to break down under adverse selection (and then the insurance companies impose pre-existing condition limitations on eligibility to buy insurance, so people with asthma cannot buy even catastrophic insurance).</p>
<p>Yes, even healthy young adults who have NEVER had any hospitalizations for asthma and have had it well controlled their entire lives cannot buy health insurance – our S was rejected by esurance and every individual policy we tried to get him. We were able to get a few options because he had always had BCBS, so they offered him some catastrophic coverage with a significant deductible and copay. He could also have gotten an alumni policy, but I didn’t pursue that because it was not a company that most of the HI providers were familiar with.</p>
<p>Sometimes going to a doc & experts far away sooner can save time & money for everyone if they can do a better job than all the local docs, who work on you until they abandon you.</p>
<p>Getting routine care in the ER is just a very poor and expensive way for care; unfortunately, that is what happens all too often the way the current system exists because people can’t be turned away from ER rooms, at least in our state. (They may wait and wait and wait to be seen, but they do eventually get seen and treated.)</p>
<p>People can’t be turned away from ERs anywhere - it’s federal law, EMTALA: Emergency Medical Treatment and Active Labor Act. That law was passed in the 1980s because hospitals were literally turning away ambulances with sick and injured patients who didn’t have insurance and weren’t rich.</p>
<p>As HImom noted, ER visits are far and away the most expensive way to care for someone. Every other modality is cheaper. But uninsured people have no other option - so ERs fill up with non-emergent patients and the costs get eaten by the hospitals, paid for by inflated billing for everyone else. There is nothing about this system that makes any financial sense.</p>
<p>It is understandable that those who have medical conditions requiring expensive prescriptions do not want to have to pay for them. It is also understandable that those who have no chronic health conditions do not want to have to pay for other people’s treatment. The latter people may have a stronger incentive to see costs reduced. The former have a stronger incentive to see the costs spread around to everyone.</p>
<p>Re: the uninsured and the ER. They do have another option. They can go to a doctors office or clinic and pay cash. Of course this does not apply to people who have <em>no</em> money, but it does apply to the “free riders” some posters keep referring to. If you’ve got money and no insurance coverage, right now you will pay for your medical care or else your credit rating will be ruined.</p>
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<p>The only people who go to the ER for routine care are people with no money, or next to no money.</p>
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<p>As if someone who’s poor and chronically ill gives a flip about their credit rating. Pay the hospital bill or pay the power bill? Not a hard choice. The hospital can bill all they want, but you can’t get blood from a stone. Billions of dollars in ER bills are written off every year and those costs get passed along to those who do have insurance.</p>
<p>The free rider problem is completely intractable unless we’re willing to a) have some sort of universal insurance system or b) swipe everyone’s credit card at the door and turn away anyone who can’t pay, too bad, go die in the streets.</p>
<p>Given that we live in the richest nation on Earth, b) is both morally bankrupt and unacceptable to a wide majority of Americans. So, tax everyone and pay for health care that way.</p>
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<p>Virtually everyone will have a chronic health condition at some point in their life - usually near the end, but it also happens at other points in life. Which is why we instituted Medicare, because the elderly were uninsurable. The fact is that the number of people who never significantly draw on the resources of modern medicine is basically negligible.</p>
<p>So what those people are really saying is that “I don’t want to pay for anyone else’s care, but as soon as I get sick, I’ll definitely want everyone else to pay for my care.”</p>
<p>You are very cynical about people, polarscribe. I do like to think that most people do care and would try to do the right thing. I am probably wrong.</p>
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<p>No, I’m not cynical, I’m realist. Faced with a $3,000 bill for an ER visit, what do you think a working-poor person who makes $30,000 per year before taxes is going to do with that bill? Do you think that person can afford to pay it, or any significant part of it?</p>
<p>I’m 29 years old, and have had a chronic health condition for the last three years that will probably remain with me for the rest of my life. I suffered a pulmonary embolism in January 2010 and spent three days in intensive care. Now I’m on a lifetime regimen of anticoagulant drugs that require medical consults and blood tests on a weekly or monthly basis. Outside of group-issue plans, I am now completely uninsurable.</p>
<p>The hospital bills for my stay were over $15,000. I was insured under a student health plan, but otherwise my income at the time was basically zero and I had zero assets. If I hadn’t been insured, guess what? I would have sent the bill back saying “Sorry, can’t pay this.” Because I couldn’t. I probably would have filed for bankruptcy and dumped the debt. Remember, blood from a stone. You can’t collect what doesn’t exist.</p>
<p>A huge percentage of personal bankruptcies today are because of medical bills.</p>
<p>The only people who go to the ER for routine care are people with no money, or next to no money.</p>
<p>Actually, this is untrue. Many people come to the ER because they don’t want to wait for a doctor’s appointment. I have seen many patient who, when I ask “did you call your doctor for this ear pain?”, say, yes, but I couldn’t get an appointment until 3pm, and I didn’t want to wait. Umm? What?</p>
<p>We, as a society, have to change our need for instant gratification. If you have a fever, it’s okay to take Motrin and wait a day or so to see a doctor. When you come to the ER because you have had a fever for 2 hours (and you have not taken anything to bring it down because you wanted me to “see it”), there is a good chance I’m not going to find anything wrong. But, because you are in the ER, I have to do a workup which can get expensive.</p>
<p>As for ACA, illegals are exempt and in my area they are the biggest abusers of the ER. When asked why, they say because when they go to the clinic they have to pay a copay, like 10 or 20 dollars. They come to the ER they don’t have to pay anything. I guess they don’t care about their credit rating and ignore the bills when they come. :)</p>
<p>I’m sorry about your condition, polarscribe. </p>
<p>I think everyone should have insurance, if they can afford it. But I’d like to see the costs of care come down, is all I’m saying.</p>
<p>My friend who chose to start her own small business was one of those “free riders” for quite sometime, because she felt she could not afford insurance. She lived a very healthy lifestyle and paid her medical bills in cash. I suppose if she had had a catastrophic injury or cancer, she might be dead today, but that was apparently a risk she chose to take. Fortunately it did not happen, her business never really took off, and she now has a job with insurance coverage at a university.</p>
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<p>dkitty,
Did someone on this thread say this, or did you just make it up?</p>
<p>I went to the ER once in the middle of the night years ago, because my throat starting swelling/closing up. I got a bill for it, which I (and my insurance co) paid.</p>
<p>We have several urgent care centers near my home now, one of which is open 24 hours. That is where I will go if I ever have that situation again.</p>
<p>dkitty,</p>
<p>Don’t ER’s require patients to first provide all of their insurance information before treatment, if it is not a true emergency?</p>
<p>Bay, your throat closing up is not “routine care”. That’s an emergency. Like what an ER is for.</p>
<p>Yes, I think you are right, romani.</p>
<p>I would not go to an ER, unless I felt I had no alternative, because my insurance deductible is so much higher at an ER. If I go to a walk in clinic, the deductible is the same as a doctor visit.</p>
<p>I guess I was trying to think of an example of people with money using the ER for conditions that are not true emergencies. I thought of one: years ago my H had a fish hook through his finger after regular doctor office hours, so he went to an ER to have it removed. Today he can go to a 24-hour walk in clinic for that type of situation.</p>
<p>If I call my doctor, any doctor, the recording before I even get to the on call person is to go to the emergency room. The ER gets plenty of people who are insured and are sent there because that is where you get treated. Many doctors don’t actively treat anything. IF it’s an acute situation, off to ER you go, and that;s often the fastest way to get directed to a room in the hospital or to an ambulatory same day treatment center there to get the issue resolved.</p>
<p>And, yes, it is a fact of life if someone can’t pay a huge medical blll, they just won’t. For those who qualify for low income state programs, hospital relief funds, and medicaid, the bills can get diverted there, which would likely have happened in Polarscibe’s case, had he had no insurance. That’s what my one son did. He is poverty level and no way he can pay for any health insurance or medical bills. That he actually was insured at the time has caused a mess, and now he does have to pay what the insurance did not cover, still a hefty sum, which if we did not take over, he would just let it go. His credit is bust anyways.</p>
<p>The way it is supposed to work is that everyone has to get insurance. Those who do not get it and go for medical treatment will now be owing Uncle Sam and his long arm will go right into your tax rerunds and any other money. They’ll wait till you go for any federal money, and until you pay up , you won’t get it, or they’ll take the back debt out of it. There are those whose Social Security checks are liened for money owed to the feds. So, yes, they will get their pound of flesh in a way that private companies cannot collect. They are also not encumbered by any statute of limitations . You owe taxes, student loan money, you owe until “death do you part” and you can’t divorce those things. You get a job, they can take out the money just as they can SS. A lot of ways to track and get you what you own when you “the Uncle”. Worse than owing “the Godfather”.</p>
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<p>If it’s a for-profit hospital, sure. Many non-profit, religious and government-owned hospitals won’t, because they’re charity care institutions with a mission to serve those who otherwise can’t afford care.</p>
<p>On a very practical note…as in we could do it today if the political will were present…I’d like to see a NPC for medical providers. If our Universities can do it (when forced) so can our healthcare providers.</p>
<p>Imagine…you know you are going to need XYZ. You enter your insurance info and some other details into a providers system and …magic…you could now know BEFORE hand that provder A charges X and provider B charges 4X. I didn’t make up these multipliers. In one instance I decided to take my EOB with it’s magical and mystical coding numbers and call other local providers in my area to assess the base charger rate for a procedure. The provider I went too was 4X more expensive than another provider half a mile down the road. NOW I know never to go to provider A unless it is an emergency.</p>
<p>Now, this wouldn’t work for an emergency situation during the time of the event. But, you would still be able to access emergency room costs at another time. As someone else pointed out earlier (Bay?) we can do this cost evaluation in the cosmetic services area right now. Just call and ask.</p>
<p>Once all the cloak and dagger was taken out of the pricing structure consumers could at least make an informed decision. This would be an example of where the free market could assist in bring prices down.</p>
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I am not sure thats is correct. Hospitals will require patient information and any insurance information to be completed, as well as signed release/informed consent forms, permission to treat, etc in advace of being seen for care in a a non emergency situation. Even if a hospital is religious based, they will file insurance to cover medically necessary care for their patients. The only system I can think of that might not typically require info on outside insruance is the VA system, but they will still need to be sure the patient qualifies for services, and I think I recall hearing they were also filing secondary insurance when the patient had it to cover copays/coinsurance costs.</p>
<p>If the patient has insurance information, of course they’ll ask for it. But if the patient doesn’t have any insurance, there’s no information to give.</p>
<p>The problem with the system isn’t people who have health insurance. If you are covered, the system kinda sorta works, if rather inefficiently. It’s the growing millions who don’t have any insurance that are causing the system to break down. And of course, there was the problem that if you got sick, you could never get insurance again because you now had a “pre-existing condition.”</p>